[Symptoms] CNS Apnea

[vsheline]

I couldn't figure out how to change the vertical scale.

Hi mandali44,

I use a different program than SleepyHead and don't remember using SH how to set the vertical scale on the Flow. I would think the instructions would be in RobySue's great beginner's guide:
http://www.apneaboard.com/wiki/index.php...epyHead%20

You are having too many hypopneas. There may be a Central component to these hypopneas but I think they look predominantly obstructive in type. The stop & go jumpiness in the Flow waveform (intermittently jumping to zero and back) is an indication of intermittent obstruction.

ASV machines nearly always eliminate central hypopneas and central apneas, so your apnea and hypopnea events will usually be predominantly obstructive in type.

I suggest two things, increasing the Min EPAP by 2 (to 10) and increasing Min Pressure Support (Min PS) by 2 (to 2).

EPAP (Expiration Positive Airway Pressure) is the Mask Pressure during exhalation, and Pressure Support is the boost in pressure added while you are inhaling, helping you to inhale. Your pressure while inhaling (IPAP) is always EPAP + PS. Your machine very slowly adjusts EPAP throughout the night to minimize obstructive events and nearly instantly increases PS if you suddenly stop breathing or reduce breathing effort.

Setting the Min PS to 1 or 2 will let the machine always be doing for you at least a small portion of the work of breathing. When the machine needs to be doing all the work of breathing for you (such as during a central apnea) it will automatically quickly raise PS to around 10 or perhaps higher.

In general Apnea Board recommends making adjustments gradually, changing only one thing at a time and waiting a week or two or longer between adjustments, so the effect of each adjustment can be seen.

Increasing Min EPAP is more important, so I suggest the Min EPAP be increased to 9 for a week and then to 10 for a week. Then the Min PS increased to 1 for a week and then to 2 for another week. If you can ask your doctor to ask your Durable Medical Equipment (DME) provider to do it for you, that would have the benefit of involving your provider.

Some doctors do not take the time to look at the Flow waveforms (do not think it is necessary) and might not be experienced in interpreting Flow waveforms. I have no idea whether that may turn out to be the case for you, but if it does, in my view that would be a good reason to search for a more proactive doctor.

Take care,
--- Vaughn

[mandali44]

Thank you so much for your suggestions. I have appointments on Friday, first with the respiratory therapist and then with the doctor. I will bring a printout of your suggestions and the SleepyHead results. I don't believe that my doctor will have a problem with my bringing in suggestions. He has been responsive to my questions.

And thanks again to everyone who has helped me.

[trish6hundred]

Hi mandali44,
WELCOME! to the forum.!
I wish you good luck with your CPAP therapy and getting it fine-tuned to meet your needs.

[richb]

Vaughn makes a good suggestion about increasing your EPAP (slowly). You first need to eliminate any Obstructive Hypopneas. Keep records and label your graphs as you save them so you can refer to them as you go. Most Sleep Doctors are not familiar with Sleepyhead. Many also do not like to hear that you are getting advice from this or any other Board. Go slowly with your Doctor and their staff. Do print out a few graphs and bring them in. I never mention the Apnea Board during my Doctor visits. I found and printed out the original research papers and info from machine manufacturers as my sources when dealing with the Docs. Over the next day or so you can download the Clinicians Manual for your machine and learn how to change your machine settings, if you like. You might find that your Doctor has not and does not look at the graphical output from your machine. Docs will just look at your AHI and make random suggestions or tell you to give it more time. Your Hypopneas are just the first thing you need to deal with. Just re-read your original post to see why you came here.

Rich

[mandali44]

Thank you for good advice. I will tread carefully. However, since it is the respiratory therapist who actually works with my machine, I may be able to learn how to make changes myself. I agree with you that doctors may not really look at the graphs. I doubt that my doc has so much as glanced at the printout from my SD, at least he hasn't mentioned any results.

[vsheline]

Thank you for good advice. I will tread carefully. However, since it is the respiratory therapist who actually works with my machine, I may be able to learn how to make changes myself. I agree with you that doctors may not really look at the graphs. I doubt that my doc has so much as glanced at the printout from my SD, at least he hasn't mentioned any results.

You can obtain the setup manual for your machine (which tells how to make changes) for free, here:
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

[richb]

In my first reply to your original post I offered a caution about CHF and suggested a possible treatment for daytime apnea. You are going to see a pulmonologist who will/should check for the many other causes of daytime shortness of breath. The Mayo Clinic has a list of the many causes of shortness of breath. http://www.mayoclinic.org/symptoms/short...m-20050890 One or more of these causes (pulmonary hypertension, for example) can be caused by sleep apnea. It will be very important to rule out the other causes before treating shortness of breath as if it were caused by Central Apnea alone. Pulmonary/Cardiac disorders can cause Central Apnea.

Rich